Delivery System Redesign

Delivery System Reform Incentive Payment (DSRIP) initiatives are part of broader Section 1115 Waiver programs and provide states with significant funding that can be used to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries.  While they originally were more narrowly focused on funding for safety net hospitals and often grew out of negotiations between states and HHS over the appropriate way to finance hospital care, they increasingly are being used to promote a far more sweeping set of payment and delivery system reforms. This brief examines similarities and difference across key elements of DSRIP waivers in six states – California, Texas, Kansas, New Jersey, Massachusetts, and New York.
 

Oregon has taken significant steps to transform its health care and early education systems. Recognizing that good health is a key component of ensuring children enter school ready to succeed, Oregon is now aligning the two systems with the ultimate goal of improving kindergarten readiness. This report describes Oregon’s approach to aligning its two innovative system transformations and highlights key strategies – including joint staffing, blended funding, and shared expectations – to elucidate lessons for policy makers seeking to bridge health care and early education.
 

The combination of fee-for-service payments and the US health care system’s standing commitment to treating existing illness discourages spending on the behavioral, social, and environmental (that is, the nonmedical) conditions that contribute most to long-term health. Pay-for-success, alternatively known as social impact bonds (SIBs), offers a possible solution. The pay-for-success model relies on an investor that is willing to fund a nonmedical intervention up front while bearing the risk that the intervention may fail to prevent disease in the future. Should the intervention succeed, however, the investor is repaid in full by a predetermined payer, such as a public health agency, and receives an additional return on its investment as a reward for taking on the risk. These efforts, supported by key policy reforms such as public agency data sharing and coordinated care, promise to increase the number of evidence-based nonmedical service providers and seed a new market that values health, not just health care.
 

Youth with complex behavioral health needs face a range of challenges and often receive services from multiple agencies that do not always coordinate services and care plans. Care Management Entities (CMEs) are designed to coordinate services provided by state agencies, and ensure services are comprehensive and not duplicative. This new Implementation Guide provides information about the CME design process for states interested in implementing or improving CMEs for youth with complex behavioral health needs. The guide focuses on experiences of the three CHIPRA quality demonstration states, Maryland, Georgia, and Wyoming, who are using funds to implement or expand CMEs.
 

The new National Scorecard on Payment Reform shows commercial health plans have dramatically shifted how they pay physicians and hospitals, with 40 percent of their payments now designed to encourage health care providers to deliver higher-quality and, in some cases, more affordable care. It also shows a 29 percentage point increase over 2013, when just 11 percent of payments were value-oriented. However, 60 percent of payments remain largely in traditional fee-for-service. While the Scorecard findings are not wholly representative of all health plans nationally, they offer a baseline against which to measure progress toward value-oriented payment in the commercial sector.